Permit MASTER PERMIT
It CITY OF TIGARD �,
PERMIT #: MST2007 -00028
COMMUNITY DEVELOPMENT DATE ISSUED: 3/7/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25111 BC -02700
SITE ADDRESS: 10380 SW CANTERBURY LN ZONING: R - 3.5
SUBDIVISION: TIGARDVILLE HEIGHTS LOT: 005 JURISDICTION: TIG
PROJECT: MILLER
Project Description: Master bedroom addition and bath remodel.
BUILDING
REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: FIRST: 250 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: DWELLING UNITS: THIRD: sf RIGHT: 5
VALUE:
OCCUPANCY GRP: R3 BDRM: 1 BATH: TOTAL: 250 sf 30,000.00 REAR: 15
PLUMBING
SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: 2 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: 1 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
• MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 1 CLOTHES DRYER:
FURN > =10OK: UNIT HEATERS: HOODS: OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: 1 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 3 SIGNAUPANEL: IN PLANT:
MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp /volt :
PLAN REVIEW SECTION
Reconnect only:
> =4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS:
This permit is subject to the regulations contained in the Tigard
Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable
PAUL MILLER NEIL KELLY CO laws. All work will be done in accordance with approved plans. This
10380 SW CANTERBURY LN 804 N ALBERTA ST permit will expire if work is not started within 180 days of issuance, or
TIGARD, OR 97223 PORTLAND, OR 97217 if the work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952- 001 -0010
through 952 - 001 -0080. You may obtain copies of these rules or direct
Phone: 503 684 - 8513 Contact #: PRI 503 335 - 9245 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
FAX 503 -287 -3574
Reg #: LIC 1663
TOTAL FEES: $ 834.73
REQUIRED ITEMS AND REPORTS
(/\..-----......-----
Issued By : /5�e, Permittee Signature ,
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
IlL ,
•......., .10 , r-r r — c,.." 4.--,-..... _
Btilding Permit Application FOR. OFFICE USE ONLY
•' City of Tigard RECEIVED Date / Recei ved • M5��O7_-
: , 2 10 Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review �1
-
IN
Phone: 503.639.4171 Fax: 503.598.1 1N 1 2 2007 Date /B : =TWA_ E t Other Permit:
TIGARD Inspection Line: 503.639 Date Ready /: : G /Q-7 Jur • El See Attached Checklist for
Internet: www.tigard- or.gov CITY OF TIGARD Notified /Method: V� ' I CQ Supplemental Information
BUILDING DIVISION
' : ., :: � �..
RE CIIItET1:DATAI= :AND =F' ;Y EELING:
, • Q.. � I •
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performe dollar) of all
Addition/alteration /replacement ❑ Other: equipment, materials, t
, labor, and the profit for the
o,'<. \:, >, _ Wit :. gi a;.r. R : ' ' ' -,,
'� 't � � work indicated on this application.
CATEC RY,, a ,, '"
. ` O �CUNSTRU �'T1V> -�..� - ,�, y v�•,:,.- ^ y; ,,
`a`: =����, �•�s'� ".m: �:.?�..... .. <.. '.: �c�:.,. .., �; ..... ;. �.:z�•�E::e�..��:�s ..•�.. .fir.: ..,. .v;:; ''a
ixt Valuation: t OA ory
1- and 2- family dwelling ❑ Commercial /industrial 7 ,
I.
❑ Accessory building ❑ Multi- family Number of bedrooms: f
❑ Master builder ❑ Other: Number of bathrooms ��
as ,;: s ;dam:: .,,;,:,c•� '�^ �
° ` ' ; ;. • T �""" <" Total number of floors:
1, :, , IUB St E;INFgRMAI'IUN t 0.. 4.- :.IaO , ATi().N N:_..
..:•,:...a r <�� s a:;,..:....4 �. �. �,Ta,. , m,- ••� - a�'t.��,^ „...�a!� � mss.... �� ... . ,,.. _ ., a::�•,€u.� Li
• Job site address: t r) A 0 �Lk) Ca,A \..e -,,-ko 1 n e.._, New dwelling area: (C, f� square feet
l City/State /ZIP: ‘u � c , v C C% 7 -2 l 7 Garage /carport area: 'lJ square feet
J
Suite/bldg. /apt. no.: Project name: p M , , Covered porch area: square feet
Cross street/directions to job site: GSL,. kt:DUv/kA lU ,]' f:74 Deck area: square feet
- 1 ��
I b ��o I �v t 1 IJT(! Other structure area:
square feet
t�M° � �� -� ,�_ .�. ,. � ..,,Y,.,�.. mss:;,„ -;
� I�;REt2 IR l? D l'T e61S4MERC r5 =USE":CHECICLI Yil •
Subdivision: \ . v ; q Ke..i\� Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: 2 ; > 3 � 6 Z.1 CO '02 -it Indicate the value (rounded to the nearest dollar) of all
,. .,.. r P t
\\\ , ,, ��, �overhead, and the profit for
h
equipment, materials, labor, a e r
r ` " fa .;;C <� ` y I work indicated on this application.
,. >;DESCRIPTI l' '' K., ; ,, d o tht
� . - �;.�`, _ . , A:: =s, � :tea °::��;:az.i' m ., f . .. . �aa .::_'y�ma.: °aom
Valuation: $
V..et/Vl0 Existing building area: square feet
New building area: square feet
1:,!'± ;��_r °� ��:- 3;���'�,� ��: �:.:� ��- :_ =tea... �:,:
PRO cliff aOWNER° 3b ,TENA Number f stories:
t.._
�" u�> ` � o
.. .,, a �,��< .a.�. ... •�,5";4iS \: �.5�.. aS�s.� , .. .., • ,. „ . :�:r.. .ZT >�. ... ';:XN'.C.: .. ��� zra ..., ..a,
Name: `� � 1 ; \ .. e. ,,..— T ype of construction:
Address: I (:)3 l 'c ,t,J �(.4k-e- jL vj \.-.G(.(A f__. Occupancy groups:
City/State /ZIP: vd . e l / 2-2:5 Existing: e •
Phone: 6(53 ) 6,10,, - t t3 Fax: ( )
New:
r:: ,.\.., ,�_: �a:a 5.. ev e. s3. _',�' :y�i ^. :tea,- >,_v" �._ ;.z::- -:
A CAN
Fa: C PERSON-
-. `3 ... �, . ...... .... ..... , . � . ,.. .,,.. ..:... - � z �*��:. x �;:� -..
� . . ....... . ... .. a . a: ,e ,...,e ._., . , . ....a�.,+, .... \. , .c ...... �: a�.:. . ..; a ., . a *' ' ' ': . . - M :.: a$, s Vi.'"y � : N , - . >.
( Q :��', «•• ,..: 4.�y \ �\0...,,��,3..,,,,;�� ..rc n �d.' °;
Business name: 1,..... t l M , �`j-i 00_,s ` c22(/vt0 Act e_ t- All contractors and subcontractors are required to be
J Ore
licensed with the Oregon Construction Contractors Board
Contact name: (� A4" , g
under ORS 701 and may be required to be licensed in the
Address: 1(34 1-.-t l \o•e_t/,c,\. jurisdiction in which work is being performed. If the
City /State /ZIP: -- \_ \� vik �_ c: � Z( '�
` applicant is exempt from licensing, the following reasons
2 '7,f-67 apply:
Phone: (5);) 33 — 1 q 2C�( Fax: : (5703 — 3 7 - S I
E -mail: - I - - C , 0 e 1 ( :, cowl
4 .P- ., -g =;- CoNTRA 1 k ... :: ' .,
Business name: ' Gt(Mic pl S Gl v t,-) t 'tL(Vl4_____ ' ` IATI MING;PERMI TIED S :w `�"'r'W '
^u .
:p =_.: ._: .�...
Address: .: ....... .(Pl ease refera jee'rschedirle) :_ ; '.;:„
City /State /ZIP: Structural plan review fee (or deposit):
Phone: ( ) Fax:( )
FLS plan review fee (if applicable):
CCB lic.:
1 (=> \3/ a `O Total fees due upon application: 62 20S . V
Amount received:
Authorized signature: `� ✓ l
This p ermit application expires if a permit is not obtained
L Print name: �`e& W v ` v,� Y ` - 1 r / ` - 0 within 180 days after it has been accepted as complete.
Date: * Fee methodology set by Tri- County Building Industry
Service Board.
I: \Building \Permits \BUP- PermitApp.doc 03/21/06 440- 4613T(I 1/02 /COM/WEB)
02/09/2007 FRI 10:41 FAX 503 287 3574 Neil Kelly North Z002/002
.
.atc.Ephaneal. Permit A 7tEtiCon E‘,,...F,_: ) . ..0,.....„...: l SEONf.Y . 7:
City of Tigard Received
Date/By. 4.: 9 D 7 Perna No.: y9r:per)7---CM,2.0
. 0125 SW Hall Blvd., Tigard, OR 97223
II I II Review
Phone: 503.639.4171 Fax: 503.59.B DatelB
.."
"r 0 9 2007 Plan
Other Pennit:
y.
I L.
Inspection Line: 503.639.4175 '
TIGARD Doe Ready/By: Juni 4 El See rage 2 for
Internet: www.tigard-or.gov ,. Notified/Method: Su ppleraeotal Information
Lit Y Ur Lk
•
.
. .
. . .
. . - '- .1* • - ' . .' COMMERCIAL - PEE!' .SCREDULEUSEtliECICLIST
El New construction gAdici;io al teration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION * :.
• Value: $
' • - :- • -.: •
A I- and 2 dwelling 0 Commercial/industrial 0 Accessory building . RESIDENTIAL EQUIPMENT /SYSTEIVLS FEES*.
For special information use checklist
0 Multi-family 0 Master builder 0 Other:
Description I Qty. 1 Ea. I Total •
• " -. . . ,..:.: . .. •JOB. SITE trqFpam4TtoN..AND ;LOCATION . • . . • : ... , : Heating/cooling
i „
Job site address: V r_5 -, 5(,J3 (..._ati\--ev\cy.._)....k \—C-6,/`e.-, Air conditioning or heat pump
0i:quires site plan showing placement) 14.00
.-------
City/State/ZIP: \ ave t, . q 7 2-`2= • Furnace 100,000 BTU (duds/vents) 14.00
'
Furnace 100,000-1. BTU (duets/veins) 17.90
Suite/bldg./apt. no.: F name: "1.2, IN.A,. k k, Gas heat pump 14.00 I
Cross street/directions to job site: / L. ' k.- " . Duct work I 14.00 ika
—
— SW \ "2 1-1ydronie hot water system 14.00
0., .i(i\-.. - ( (:( /1t . V`e---- Residential boiler (radiator or
'---' hydronie) 14.00
Unit heaters (fuel-type, not electric),
in-wall, in-duct, suspended, etc. 10.00
Subdivision: Lot no.:
Flue/vent for any of above 10.00
, Other: _ 10.00
Tax map/parcel no.: Other fuel appliances
- . . ' •••-• . • " DESCRIPTION OF..WORR - . . Water heater 1 10.00
(p ._'l ... -,---,-, Gas fireplace 10.00
c rli■ c2.etvt&a.a. - cmi . A Flue vent for water heater or gas
fireplace 10.00
AA . ) #.. .... V ' -,.... -. ...) -: Loglighter (gas) 10,00
k...... Wood/pellet stove 10.00
Wood fireplace/insert 10.00 ,
:: • • * - - - ' .PROPERTY. OWNER • 1 '. -, " . E3 TENANT
.....
Name: 1 6 ..k ,....) 1 i'LkT e Ao/ Chimney/finer/flue/vent
Other: , 10.00
Environmental exhaust and ventilation 10.00
.,., Range hood/other kitchen
Address: 16 St_A__) CC,tykkap_AA;:i(_,V1 „--12‘..V\E-- equ ipment 10 00
.
City/State/ZIP: City/State/ZIP: .-----:. \ 6- vi CAI_ &I 1 -2--7-; Clothes dryer exhaust 10.00
- Single-duct exhaust (bathrooms,
Phone: (56y:2) ( ....... .,... -3 Fax: ( ) toilet compartments, utility rooms) 1 6.80
. -- - I -- . - APPLICANT - - -. CI ,
- CONTACT. PEiRSON . Atticknisvispacc fans 10.00
Business name: 00_V--( 9r6AviLi
Other
Poet piping 10.00
• Contact name: ( \ (-)\/\ S5.40 for first four; $1.00 for each additional
Address: 6 c Alk)-e_Or& '--- Furnace, etc.
Gas heat pump
City/State/ZIP: . 1 . 6 .> v - t ri a 08, ( a, 972- 7 i
- . Wall/suspended/unit heater . •
Phone: (:) -3 - 9
1 24.;"),.) • Fax: : 3) r -,. 7 4, Water heater
• - Fireplace
E ....\_ec\ \ a s . ,:_•,_..,....,,,,, Range
Barbecue
Business name: ,..rte . ,A...e-> A 1142--' Clothes dryer (gas) Other:
Address: " ... • .. MthiTANItALPtillVffrizE0* - .'''.'..--.-::.'"
City/State/ZIP: Subtotal 2434
Minimum permit fee ($72.50)
Phone: ( ) Fax: ( ) •
Plan review (25% of permit fee)
CCB lie.: b I , LL . 2..., State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: , • 1 This permit app
/---- -------------
( ..._..,1
lication expires if a permit is not obtained within 180
days after it has been accepted as complete.
1 p fitlt name: \ ,e..A, ,)rv,156Y1 Date: 2 -52 ....-5-7 . Fec methodology set by Tri.Colulty Building Industry Service Board
I: \fluildinOcrmilsWEEC-PerrnitApp.doc 01/06/06 440-44171' (11/CIJCOMAVED)
g - a aeLa- TB2 -COS s4Tui-laci Z3 d9f7:20 LO t uer
FROM : COHO ELEC tR I C FAX NO. :5035829840 Feb. 08 2007 09: 07AM P2
neptrical.Perniit. Ap 1. :
itICINIFD .. FOR OFF10E USE ONLY
City of Tigard Itticeived 2 007 ,e, : 1 , 42 7
Permit Nu, HOTR.:2,7 - ekeie:P dr
Dine/B i
13125 SW ',Hall Blvd., Tigard, OP FEB 0 9727,3 •
Plan Tiayiew
Phone: 503.639,4171 Fax; 503.5gg.1960 .
g
", vo
Datc/By:
_
Other Penn&
lospeetion Line; 503,639.4175 CITY OF T:GArl,4 h1 \ Datricody/By: lune;
LO___ See Page/ fur
Internet: www.ci.tigard,or,us BUILDING DWI& . 77 Notified/Method: Suppletnentsd Inforiontion
—
TYPE 0.F WORK PLAN REVIEW
.. ,..___
E New construction AcIdi tion/alteratiOn/replacem.ent Please cheek all that apply:
0Serviee over 225 amps, comm 0Bazardous location
D Demolition E 01.ber:
..,.
Service over 320 amps - rating 01.1uildtig over 10,000 sq. ft.,
...,“ CATEGORY OF CONSTRUCTION '
of 1 and 2-faaiily dwelling or more new residential
1 - and 2-family dwelling 0 Commercial/industrial 0 Accesaory building ['
'
0 r - s 4 System over 600 volts nominal units in one structure
0Building over three stories 0 Vcccicrs, 400 amps or more
Multi-family Master builde 0 Other:
Occupant load over 99 persons 0Manufactureci stilt Clures or
30B SITE INFORMATION AND LOCATION LIEgregsAightin plan RV park
• ,... .
0 Other:
Job no Job site address: o v.....el ,,_,_.
..
_
f o a l c p il l i a tY ns with any of the above.
City/State/ZIP, t Inc__ ) o p . cl- a .. ; ..,,
T:a __
L„ry,_ The above arc not applicable to temporary construction Service. :- .....
FEE* SCHEDULE
Suitc/bIdglapl, no.: Project name: NI \<_. in \ \
,.. __,... ... - -. beterlption - Oiy. 1 Fee, 1 Tntni [ **
..,_ .
CroS8 Street/directions to job Site: New residential single- or multi-family dwelling Ana.
- Includes attached garage.
. —
. . ... . . • . .. 1,000sq. ft. or less 145,15. . 4
.. -, .
.,,...._
Subdivision: Lot no.: Ea. add'I 500 sq, ft or portion 33.40 1
Limited energy, residential 75.00 2
Tax inup/pai7cel no.:
.. . • ' Limited energy, non • , 75.00 • 2
DESCRIPTION OP WORK • Eaell manufactvrcdot modular " _ „.._
,...
•
:,_.....,\.__ dwelling, service and/or-feeder . 90,90
4 2
v---■ • 'ff •&•, , Services nr feeders installation, alteration, and/or relocation
....
,, A• \ N5."A"'. --J,4-311...12) 200 amps or less 80,30 2 - 106,85 2
.7.4 PROP W
ERTY OWNER 0 201 amps to 400 amps TENANT
,...
401 amps to 600 amps 160,60
Name: IP F•'% - :\ n,..1\lv- 60 1 amps to 1,000 ornpg
240.60
– – 2
— ...
Address: 03 C ? . C. C ."' .. .,...4ear-b • 2
.__,,k_sr...., ov. 1,000 ampS Of Wilts . 454,65 2
.. - ' .,..
Reconnect only 66,85 2 1
____
City/Slate/ZIP: \ \ , (.•'( cl l .- la - 3.3 Tempnrary services or feeders Installation, alteration, and/or
,,,,_a •
relocation
Phone: ( ) Fax: ( )
200 amps or less 66.85 1
,..
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exelian8e, according to OR.S 447, 449, 670, and 701. . '
4() I EL1111)F to 600 amps 133.75 2
Owner signature: Date: Bra nch circuits - new, alteration, or extension, per panel
— ,.._ „... - , -- . - _ .
0 APPLICANT I 0 CONTACT PERSON • A. Fee for branch circuits with
service or fcador fee, each
6.65 2
Business name:
branch circuit ...
'
B. Fee for branch circuits
Contact name:
without service or feeder fee, I
. t.....k 2
each branch, circuit
46.85
. Address: . .
Each add'! branch ci.rouit a 6_65 ,
City/State/7.IP; , • ,
. Miscellaneous (service or feeder not tiielncled)
'.. ...., ,. „
2
Phone: ( ) . Fax: : ( ) Pump or irrigation circle 53.40
Sign or outline lighting
53.40 2
—
E-mail: :
• Signal circuit(s) or limited-
,.
CONTRACTOR energy panel, alteration, or
' extension, Describe: Page 2 2
Business name ... 7.- • • '-
..—_, _ ...._ ,.._
Address: Q) )Csve< t (t..t' Each additional inspection over allowable In any of the above
_
—,....
- " -. ... Per inspection 62,50
City/State/ZT.P: ‹,,, ‘,' (•/:.,) t ,.. ,, , --- iL_ ., ,
Investiga tion per liour (1 kr min) 62.50
Phone: ( ) „5 I Fax; ( ) .... - 9 ( .§ - t ■3 • Industrial plant per hour
--„. ELECTRICAL PERMIT
CCX. Lic.: \ 5 i ( Electrical Lic,: - ,.. , _5 .:_g— Suprv. Lie.: _ \
Subtotal Ce
.
Supev. rl.ctrioiail 6isz rc 1
quirt '.;''';:,,:, 7 ,,..— ,,7.:% :',.s.t:41,igitr:' Plan review (25% of pen fcc)
■•',:' . '%, .: '''. • • 4111 = 1 .?...:= 9 • . '
_,.,
Print name: ‘17 ' Fi' State surcharge (8% of pennit fee)
' "\ k..,....;-. , ate: a .... 5s.- ,--, - S ,....., ,
.
ri ...„_
-- TOTAL PERMIT FEE '
.\
Authorized signature: -,...) . V Illi — . ' T111$ pormit application expires if a permit Is not oiiiiilned within 180
_ ,' __.) "
(litys after It has been accepted as complete
Print name: . - . 111 lir Date, - ,7N ..... „ .. 1
* Fee tnothorlology net by Tr-County Building Industry Say ine lipard
q/1", -. : ^:. .'"'
, ** Number of inspoctions per permit, allowed.
iAl I vio
440-4615Ti10/02/COM/W ER
FROM : BRUNER 1 PLUME I NG . .E-PliNg. : 6242173 Feb. 08 2007 03: 17PM P1
BuiRE'ng Fixtures ' rr. ( • -
. . .
. . .
Plum bin° Permit rit
.,..::'..,-.... . ..:' Mk 'OFFiCE USE ONLY • ' •': -...:',.: : ' f..•:Y ...,,,,,!:
City of Tigard a " LI - es n ti
r Obi I " .4,00 RCCel ved
Date/Fiy: ,0 7
3125 SW I tall blvd., 'Itgard, OR 97223 c'j,...t,
1 c
Rvicw
PllO 4 eet.'( A Daic/By.
nc: 503.639.4171 Fax: 503.598.1960 ni her permit No
, t ik3 , htl ,, 1 .
24- If our Ii spccrion Line: 503.639.4175 , ..N.1 i 1r 3 - ° - !! a_ i I
• 4,4 ''' '• 1 I )111k: heady/13y :
Intcrnct: www.ci.tigard.mus OA' 1 . ' . '''' Notified/Method: j ur i ' 7 El !+(.4.. r7ige for
7
Sli ppletnent al In form 0 inn
- ... „....,- . . ..
. TY8RIVIV FEE* SCIIEDULL
0 New construction 0 Demolition - ,.. For special information use checklist
, ,_ 1:
....„..... Doscription I Oty. 1 C. L
- .- Total
12ri1ddit ion/altera tion/repla cern ent 0 Other: New I - 2-family dwellings (includes 100 ti for each utility c oinection)
• • • . : ••• ••.CATEGOZYH OF . CONSTRUCTION . • SFR (1)hatti 249.20
-- 1 - and 2 dwelling El Commercial/industrial SFR (2) bath 350.00 ,
, .
...
ba b 399.00
(3) at
0 Accessory b El uilding Multi SFR (
Each additional bath/kitchen 45.00
E Master builder 0 Other; -
Fire
. sprinkler ( sq. !I.) Page 2
.. . „.,. , . .. . . , . ...
. . ... ., ...,; ....:....loosITE.INFQRmATIQN AND •LOTION - .
Site 'uti/itiCS
Job site address: / 0 0 . _. , /.14 i, , , t A c.E.itch basin or area drain
i 6.60
Cit y/Statc/ZIP: ,i / ..0 Orywell, leach line, or trench drain 16.60
- „..
- i -
Suite/bldg./pt. no.: Project name: r I I.P.ir' lootin drain (no. linear h.. ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60 .
-- Rain drain connector 16.60
•---
Sanitary sewer (no. linear ft,; ) Pagc 2
Storm sewer (no, linear ft.: ) Page 2
_ ...._ _....__
_ --
Subdivision; Lot no.: Water service (no. linear ft.: _,) Page 2
Fixture or item
Tax map/pareel no.: -,
- Absorption valve 16.60
. . . RESCRIFTION : OF 'WORK' . •
Back llow pi Page 2
. .
---,
Ill / / 4 0 / A .. , _ill Backwater valve 16.60
. I )1 AL a/ Clothes washer 16,60
WPM. r I W AV ilk' 1' . lir A" ......pishwasher 16.60
-_ -
tIrink ing fountain 16.60
. - , D , pRoolluty:,:oivNi*-1..:... , . - .-' '.'
Ejectors/sump 16.60
Name: ---
.. ,, P:xpansion tank 16,60
Address: Fixture/sewer cop 16.60
City/State/ZIP; ._ Floor drain/floor sink/hub 16.60
-.-_.
Phone: ( ) Fax: ( ) Garbagc disposal
16.60
• .' , ' . 0 APPLICANT ' .. ' . 0 CONTACT PERSON - . 1 bib 16.60
Ice maker 16.60
Business name:
Interceptor/grease trap 16.60
Contact name:
Medical gas (value: S ) Page 2
.._,
Address: Printer _ 16,60
City/State/ZIP: Roof drain (commercial) 16.60
Sink/basin/lavatory g2 16.60
.
Phone: ( ) Fax : ( )
Tub/shower/shower pan 16
I --1
- • -- • . .60
E-mail: -
Urinal 16.60
CONTRACTOR .--
..
• Water closet I 16
-
Business name: ) r(LnP../1" 's , JAI .1 J • till 0---) Water heater
I -
Address: -- Pp - Other:
.__
City/State/ZIP : T c iA , 4 cx _ -7 ,; Z I Subtotal
. Minimum permit tee: S72.50
Phone. (. _.33 c‘ 4 7 . 4 x 70 Fax!25 b 3 (0 Dq..„7-.23 Residential back tlow minimum perruil fee: 536.25 _
•
CCB Lic.: SIC1-, Plumbing lie, no.:260 f5.-- Plan review (25% of permit fee)
_
State surcharge (11% of permit fee)
Authorized signature .
TOTAL PERmit• FEE:
Print name: Wai- ..ru pi )---- Date: irQ C k . This Permit 2 P)ncation expires if a permit is nut obtained within
' - 1811 days after it has been accepted AS complete.
It methodology set by in-County Building Industry Sr it : Board.
iAnunding\Penr,itorjor-pormilApp.d 06/05 4•16.4616T( inimiromiw Pin
I
Building Division
TIGARD Request for Permit Action =.
... o tub g
TO: CITY OF TIGARD I RAN 1 20 07
Permit System Administrator
Q 13125 SW Hall Blvd., Tigard, OR 97223 C
Q Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-T.,
1 Ylr o o
VJ
FROM: ❑ Owner ❑ Applicant ❑ Contractor 7(City Staff
(check one)
REFUND OR Name: '
INVOICE TO: (Business or Individual) N /
* P-
N A 0 Mailing Address:
City/State/Zip:
09/0 1 '
Phone No.:
<0 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
CANCEL PERMIT APPLICATION.
ct
REFUND PERMIT FEES (attach receipt, if available).
Q ' ❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
ei ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #:
H `a i otoo — pGO ICI
Site Address or Parcel #: (p t•_)3 Cu 9 g_Q1ttk y LJ
Project Name: H 1 L LE Q
4 Subdivision Name: 4i Lot #: t...)76- J ,, ll Lot
�JLI� --
► 12�it (.� ! rT 4,e, g b A-S i t1,67nQ I C jr --- Sie/e
hhi 1 IJ 6 'T 4.9 Aos , &_i_y / 4 t,tl p 1 ) ►r (ISM ) Ec) t e.0 I
1 0 Q AP PL( eft / - - 4 WIThli Pt-t.0 APPLI eA -77oJ i - 7 �- 7 .
Signature: 0-12-04f 1 Date: / / AA 7
Print Name: . /.) 67 /7A /t. /
v W Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
Q. b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
A. c) not more than 80% of the land use application fee for issued permits.
CE ■ c) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
d) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
i 2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
I� FOR OFFICE U SE ONLY
r— 0 Rte to Sys Admin: Date I / A- 0 7 t y . / Rte to Bldg Admin: Date / /O7 B -ii• F
Refund Processed: Date #67/4<,99 By _2Nse Invoice Processed: Date By
* Permit Canceled: Date // 7/0 7 By :'•, Parcel Tag Added: Date By
Receipt # / i Date i / /� f /0 7 Method Amount $
I: Building \Forms \RegPerrrutAction.doc Rev 05 /24/06
c
CITY OF TIGARD
BU ILDI NG DIVISION PERMIT #: MST2007- 00028
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/7/2007
Phone: (503) 639 - 4171 °�tp�N
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/4/2007 TIME: 7:01AM PAGE: 67
SITE ADDRESS: 10380 SW CANTERBURY LN CLASS OF WORK:
SUBDIVISION: TIGARDVILLE HEIGHTS LOT #: 006 TYPE OF USE:
PROJECT NAME: MILLER
DESCRIPTION: Master bedroom addition and bath remodel.
OWNER: MILLER, PAUL PHONE #: 503 -684 -3513
CONTRACTOR: NEIL KELLY CO PHONE #: 503.335-9245
•
Inspection Request Scheduled For: Date: 6/4 /2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 049510 -04 360-635,2517 N
Corrections /Comments /Instructions:
6P
❑ PASS PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
I FAIL 4 ❑ CALL FOR INSPECTION ❑ ADDITIONAL F ES ASSESSED
Inspector: : '� Date: v Phone #: (503) 718-
'_;
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2007 -00028
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/7/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 �' •'
INSPECTION WORKSHEET FOR DATE: 6/4/2007 TIME: 7:01AM PAGE: 58
SITE ADDRESS: 10380 SW CANTERBURY LN CLASS OF WORK:
SUBDIVISION: TIGARDVILLE HEIGHTS LOT #: 005 TYPE OF USE:
PROJECT NAME: MILLER
DESCRIPTION: Master bedroom addition and bath remodel.
OWNER: MILLER, PAUL PHONE #: 503 - 684 - 8513
CONTRACTOR: NEIL KELLY CO PHONE #: 503.335 -9245
Inspection Request Scheduled For: Date: 6/4/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 0485/003 360.635-2517 N
Corrections /Comments / Instructions:
•
•
I ASS PARTIAL APPROVAL ❑ CANCEL NO ACCESS
FAIL I CALL FOR INSPECTION [ I ADDITIONAL FEES ASSESSED
Inspector; Date: Phone #: (503) 718- 7--‘7
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2007 -0002a
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/7/2007
Phone: (503) 639 -4171 dip
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 614/2007 TIME: 7:01AM PAGE: 59
SITE ADDRESS: 10380 SW CANTERBURY LN CLASS OF WORK:
SUBDIVISION: TIGARDVILLE HEIGHTS LOT #: 005 TYPE OF USE:
PROJECT NAME: MILLER
DESCRIPTION: Master bedroom addition and bath remodel.
OWNER: MILLER, PAUL PHONE #: 503 - 684 -8513
CONTRACTOR: NEIL KELLY CO PHONE #: 503
Inspection Request Scheduled For: Date: 6/4/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 049510 -02 360-635-2517 N
Corrections /Comments /Instructions:
£/ PASS PARTIAL APPROVAL I I CANCEL I I NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONA FEES ASSESSED
4 0
Inspector: _ Date: Phone #: (503) 718-
. CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2I107 00t1' 8
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/7/2007
Phone: (503) 639 -4171 h u i "� r
Inspection Requests (24 Hrs.): (503) 639- 4175�f I�
INSPECTION WORKSHEET FOR DATE: 6/4/2007 TIME: 7 :01AM PAGE: 60
SITE ADDRESS: 10380 SW CANTERBURY LN CLASS OF WORK:
SUBDIVISION: TIGARDVILLE HEIGHTS LOT #: 005 TYPE OF USE:
PROJECT NAME: MILLER
DESCRIPTION: Master bedroom addition and bath remodel.
OWNER: MILLER, PAUL PHONE #: 503.684 -8513
CONTRACTOR: NEIL KELLY CO PHONE #: 503- 335 -9245
Inspection Request Scheduled For: Date: 614/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 049510 -01 360 - 635.2517 N
Corrections /Comments/ Instructions:
PASS PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL I ' . LL FOR INSPECTION I I ADDITIO , L FEES ASSESSED
6
G
1 Inspector: Date: G d Phone #: (503) 718 -
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2007- 00028
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/712007
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175 __••
INSPECTION WORKSHEET FOR DATE: 5/7/2007 TIME: 7:00AM PAGE: 64
SITE ADDRESS: 10380 SW CANTERBURY LN CLASS OF WORK:
SUBDIVISION: TIGARDVILLE HEIGHTS LOT #: 005 TYPE OF USE:
PROJECT NAME: MILLER
DESCRIPTION: Master bedroom addition and bath remodel.
OWNER: MILLER, PAUL PHONE #: 503640513
CONTRACTOR: NEIL KELLY CO PHONE #: 503 -336 -8245
Inspection Request Scheduled For: Date: 6/7 /2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
322 Shower pan 047708 -01 503-740 N
Corrections /Comments/ Instructions:
PASS PARTIAL APPROVAL n CANCEL NO ACCESS
I I FAIL n I .PECTION I I ADDITIONAL FEES ASSESSED
tAg
Inspector 4/ _ Date: Phone #: (503) 718 -�
•
CITY OF TIGARD •
BUILDING DIVISION PERMIT #: MST2007- 00020
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/712007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/4/2007 TIME: 7 :01AM PAGE: 29
SITE ADDRESS: 10380 SW CANTERBURY LN CLASS OF WORK:
SUBDIVISION: TIGARDVILLE HEIGHTS LOT #: 005 TYPE OF USE:
PROJECT NAME: MILLER
DESCRIPTION: Master bedroom addition and bath remodel.
OWNER: MILLER, PAUL PHONE #: 503 -684 -8513
CONTRACTOR: NEIL KELLY CO PHONE #: 503 - 335.9245
Inspection Request Scheduled For: Date: 4/4/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 045973 -01 503 -624 -4880 N
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: l l n). Date: 41 J 07 Phone #: (503) 718-
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2007-00028
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/7/2007
Phone: (503) 639 -4171 Ja ��� Ispection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/6/2007 TIME: 7:04AM PAGE: 45
SITE ADDRESS: 10380 SW CANTERBURY LN CLASS OF WORK:
SUBDIVISION: TIGARDVILLE HEIGHTS LOT #: 005 TYPE OF USE:
PROJECT NAME: MILLER
DESCRIPTION: Master bedroom addition and bath remodel. •
OWNER: MILLER, PAUL PHONE #: 503-684-8513
CONTRACTOR: NEIL KELLY CO PHONE #: 503-335-9245
Inspection Request Scheduled For: Date: 4/6/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough -in 046088 -01 360.635.2617 N
Corrections/ Comments /Instructions:
Vt4I 2407\ j (N CG •
•
■ PASS I I PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 11 1(.)Q l Date: - 1 bit5 Phone #: (503) 718 - 2 - 1 1 1410
.
1 CITY OF ` '
��nm n ��o� TIGARD
BUILDING DIVISION ~°~~"��~�""°~� ~~.~"~~"~~"" PERM|T#: hA8T2007-00028
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 317/2007
I Phone: (503) 639-4171 At |nopecbonReque�o(24Hna.):(503)G3Q'4175 .�Wr
INSPECTION WORKSHEET FOR DATE: eK12/2007 TIME: 7:00AM . PAGE: 41
SITE ADDRESS: 103MDSW CANTERBURY LN CLASS OF WORK:
SUBDIVISION: 7lGARQ\4LLEHE]GHTS LOT #: 005 TYPE OF USE:
PROJECT NAME: MILLER
DESCRIPTION: Mstr bedroom addition and bath remodel.
,
OWNER: MILLER, PAUL PHONE #: 603-8840613
CONTRACTOR: NEIL KELLY CO PHONE #: 503-3359245
Inspection Request Scheduled For: Date: 4112/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
280 Insulation 046386-01 603-740-6519 N
Corrections/Comments/Instructions:
7:--15*A";( 7 PARTIAL APP , 7 CANCEL El NO ACCESS
FAIL CALL FOR INSPECTION 7 ADDITIONAL FEES ASSESSED
, Inspector: ` �q' .
.�' Y Date: ��-� Phone #: (503) 718- 7�9=�c
`
^- '
CITY OF TIGARD ,p
BUILDING DIVISION � � t �,,.- �A1'"'l PERMIT #: MST2007 -00028
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/7/2007
Phone: (503) 639 -4171 a n4 °
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/6/2007 TIME: 7:04AMt PAGE: 44
SITE ADDRESS: 10380 SW CANTERBURY LN CLASS OF WORK:
SUBDIVISION: TIGARDVILL.E HEIGHTS LOT #: 005 TYPE OF USE:
PROJECT NAME: MILLER
DESCRIPTION: Master bedroom addition and bath remodel.
OWNER: MILLER, PAUL PHONE #: 503 - 68443513
CONTRACTOR: NEIL KELLY CO PHONE #: 503-335-9245
Inspection Request Scheduled For: Date: 4/6/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
275 Framing 046088 -02 360-635.2517 N
Corrections /Comments /Instructions:
J � ,
112 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: . Date: Phone #: (503) 718
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: MST2007 -00028
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/7/2007
Phone: (503) 639 -4171 4p i �1
Inspection Requests (24 Hrs.): (503) 639 -4175 s' ` __L.
INSPECTION WORKSHEET FOR DATE: 3/26/2007 TIME: 7:00AM PAGE: 57
SITE ADDRESS: 103130 SW CANTERBURY LN CLASS OF WORK:
SUBDIVISION: TIGARDVILLE HEIGHTS LOT #: 005 TYPE OF USE:
PROJECT NAME: MILLER
DESCRIPTION: Master bedroom addition and bath remodel.
OWNER: MILLER, PAUL PHONE #: 503-684-8513
CONTRACTOR: NEIL KELLY CO PHONE #: 503. 335.9245
Inspection Request Scheduled For: Date: 3/26/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
235 Shear walls/anchors 045333 -01 503 - 998.2869 Y
Corrections /Comments /Instructions:
,,. -.---K.77_, - F- - -,A7 s ,,, / 7
NI LJAD
,_.---
7 f
PASS %I PARTIAL APPROVAL ❑ CANCEL El NO ACCESS
FAIL % C LL FOR INSPECTION
El ADDITIO AL FEES ASSESSED
Inspector: Date: Phone #: (503) 718- Z-
s
CITY OF TIGARD
BUILDING DIVISION • PERMIT #: MST2007 -00028
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 3/7/2007
Phone: (503) 639 -4171
A 9���1 ll
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/13/2007 TIME: 7:02AM PAGE: 53
SITE ADDRESS: 10380 SW CANTERBURY LW CLASS OF WORK:
SUBDIVISION: TIGARDVILLE HEIGHTS LOT #: 005 TYPE OF USE:
PROJECT NAME: MILLER
DESCRIPTION: Master bedroom addition and bath remodel.
OWNER: MILLER, PAUL PHONE #: 503 -684 -8513
CONTRACTOR: NEIL KELLY CO PHONE #: 503- 335 -9245
Inspection Request Scheduled For: Date: 3/13/2007 Pour Tim:. 11:00
Code # Inspection Description Confirm # Contact # Message
220 Slab 044709-03 503-998-2859 N
•
Corrections /Comments / Instructions:
•
I PASS %4 P� 'TIAL APPROVAL n CANCEL NO ACCESS
I I FAIL r// ∎ L FOR INSPECTION I 1 ADDITIO AL FEE ASSESSED
��
Inspector: ` Date: 0 Phone #: (503) 718 - Z6-
CITY ���� ��U��������
��nn n ��m on�m�mnu�w
BUILDING DIVISION PERMIT #: MST2007-00028
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/7/2007 Phonn:(503)639-4171 .
Inspection Requests (24 Hrs.): (503) 639-4175 461-'
INSPECTION WORKSHEET FOR . DATE: 3/13/2007 TIME: 7:02Ah8 PAGE: 67
SITE ADDRESS: 10380 SW CANTERBURY LN CLASS OF WORK:
SUBDIVISION: TIGARDVILLE HEIGHTS LOT #: 005 TYPE OF USE:
PROJECT NAME: MILLER
DESCRIPTION: Master bedroom addition and bath remodel.
OWNER: MILLER, PAUL PHONE #: 503-684-8513
CONTRACTOR: NEIL KELLY CO PHONE #: 603
Inspection Request Scheduled For: Date: 3V13/2007 Pour Time: 11:00
Code # Inspection Description Confirm # Contact # Message
205 Footing 044709'01 503-998-2869 N
Corrections/Comments/Instructions:
.
~
E PARTIAL APPROVAL n CANCEL I | NO ACCESS
n FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: �� ^^ 4 Date: 3 ? Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2007- 00028
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 317/2007
Phone: (503) 639 -4171 / n' d th1��6��I
Inspection Requests (24 Hrs.): (503) 639 -4175 =��
INSPECTION WORKSHEET FOR DATE: 31/3/2007 TIME: 7:02AM PAGE: 55
SITE ADDRESS: 10380 SW CANTERBURY LN CLASS OF WORK:
SUBDIVISION: TIGARDVILLE HEIGHTS LOT #: 005 TYPE OF USE:
PROJECT NAME: MILLER
DESCRIPTION: Master bedroom addition and bath remodel.
OWNER: MILLER, PAUL PHONE #: 503-684-8513
CONTRACTOR: NEIL KELLY CO PHONE #: 503-33&9245
Inspection Request Scheduled For: Date: 3/13/2007 Pour Time: 11:00
Code # Inspection Description Confirm # Contact # Message
210 Foundation wails 044709-02 503 -998 -2859 N
Corrections/Comments/Instructions:
ASS n PARTIAL APPROVAL n CANCEL I NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: .F�/ -1x4 Phone #: (503) 718 - 2.9-q----